Post-discharge follow-up of children treated for severe acute malnutrition

Severe acute malnutrition (SAM) is a major global health problem affecting some 16.9 million children under five years old. Little is known about what happens to children aged 6-24 months post treatment discharge. To investigate further, a systematic review was carried out on follow-up between six and 24 months after discharge from treatment for SAM in children aged 6-59 months. The literature search was carried out between June and August 2017. Studies were selected if they included children who experienced an episode of SAM, received a therapeutic feeding intervention, were discharged as cured and presented any outcome from follow-up between six and 24 months later. In total 3,691 articles were retrieved from the search, 55 full-texts were screened and seven met the inclusion criteria. Loss to follow-up, mortality, relapse, morbidity and anthropometry were outcomes reported. Between 0.0% and 45.1% of cohorts were lost to follow-up. Of those discharged as nutritionally cured, mortality ranged from 0.06% to 10.4%, at an average of 12 months post-discharge. Relapse was inconsistently defined, measured and reported, ranging from 0% to 6.3%. Two studies reported improved weight-for-height z-scores, while three studies that reported height-for-age z-scores found either limited or no improvement.

The authors conclude that there is a scarcity of studies that follow up children six to 24 months post-discharge from SAM treatment. The limited data that exists suggest that children may exhibit sustained vulnerability even after achieving nutritional cure, including heightened mortality and morbidity risk and persistent stunting. Prospective cohort studies assessing a wider range of outcomes in children post-SAM treatment are a priority, as are intervention studies exploring how to improve post-SAM outcomes and identify high-risk children.